Characterizing the Design of and Emerging Evidence for Health Care Organization-Based Lung Cancer Screening...

Area of Science:

• Public Health
• Health Services Research
• Oncology

Background:

• Implementing lung cancer screening (LCS) using low-dose computed tomography (LDCT) involves complex steps from eligibility assessment to follow-up adherence.
• Existing evidence supporting LDCT screening implementation remains unclear, necessitating a review of current interventions.

Purpose of the Study:

• To systematically review interventions that facilitate the initiation, adoption, or improvement of LCS programs within healthcare organizations.
• To identify effective strategies across the LCS continuum, including risk assessment, shared decision-making (SDM), and adherence to screening and diagnostic testing.

Main Methods:

• Conducted librarian-assisted literature reviews of studies published between January 1, 2011, and December 31, 2023.
• Included interventions focused on any LCS process step before diagnosis, utilizing databases like CINAHL, Embase, and Medline.
• Characterized 64 eligible studies (19 randomized, 45 non-randomized) by design, outcomes, and intervention focus, managing data with DistillerSR and Covidence.

Main Results:

• Shared decision-making (SDM) and initial LCS uptake were the most frequently studied intervention areas.
• Educational interventions, often one-on-one, dominated the reviewed studies (n=33).
• Studies showed statistically significant improvements in patient knowledge and decision-making aspects, but findings on LCS uptake were variable.

Conclusions:

• Current LCS intervention strategies primarily address SDM and initial uptake, with limited focus on risk/eligibility assessment and adherence to annual screening or diagnostic testing.
• There is a need to expand intervention strategies beyond education-focused, single-level approaches.
• Developing multilevel interventions is crucial for enhancing the evidence base and supporting high-quality LCS implementation in practice.